A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest

Abstract

Patient: Male, 65Final Diagnosis: Aortic dissectionSymptoms: Hemiplegia • hypotensionMedication:—Clinical Procedure: Emergent surgerySpecialty: SurgeryObjective:Mistake in diagnosisBackground:Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. A case is reported of the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.Case Report:A 65-year-old man was admitted to the Emergency Department with dysarthria, left facial ptosis, left hemiplegia, and arterial hypotension of 75/50 mmHg. Computed tomography (CT) angiography showed a Stanford type A aortic dissection extending to the right common carotid artery. Shortly after arrival in the operating room, his hemodynamic condition rapidly deteriorated resulting in cardiac arrest. Despite the rapid onset of extracorporeal circulation, adequate systemic blood flow could not be restored. Cerebral NIRS values remained within the normal range (70–80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased.Conclusions:Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.

The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study

“…Moreover, external factors such as cerebrospinal fluids or blood in the subarachnoid or subdural space may have an effect on the measurements [9,30]. Moreover, it has been shown that NIRS can monitor normal cerebral oxygenation values in patients with brain death [32,11,33]. It has been hypothesized that normal rSO2 during prolonged cardiac arrest may be the result of the absence of cerebral metabolism, preservation of the extracranial circulation (NIRS device is significantly influenced by the oxygenation of the scalp and skull), or a maintained residual cerebral perfusion.…”

“…However, there are several limitations to this analysis. Firstly, there are a lot of factors related to the treatment of a serious condition which may affect the monitored signals and parameters, even though they represent the real critical care environment: analgesia, sedatives, intravenous anaesthetics, and nursery manoeuvres [32]. Moreover, as it has been shown in previous research, the value of rSO 2 may be influenced by the depth and type of administered anaesthesia, the systemic arterial blood pressure, haematocrit, arterial carbon dioxide partial pressure (P a CO 2 ), arterial oxygen saturation (SaO 2 ), pH and temperature [33,34].…”

Near Infrared Spectroscopy for High-Temporal Resolution Cerebral Physiome Characterization in TBI: A Narrative Review of Techniques, Applications, and Future Directions

“…In a small cohort of 7 neurocritical care patients, 2 of whom had a TBI, Kim et al (2010) and colleagues found that changes in HgO and total hemoglobin were not significantly correlated with CBF as measured by Xenon CT. Shafer et al (2011) found similar results in a study of 22 patients, 3 of whom had TBI. It is clear that the relationship between rSO 2 and CBF is more complex as has been demonstrated in a recent case report of persistent normal rSO 2 during prolonged cardiac arrest (Maillard et al, 2019). This might possibly be explained by reduced metabolic demand resulting in the maintenance of cerebral oxygen levels in the absence of CBF.…”

The Role of Cerebral Oximetry in Predicting and Preventing Postoperative Cognitive Dysfunction

“…Since 70-80% of the blood in the brain is in the venous compartment, NIRS mainly reflects venous blood oxygenation, but the rScO2 value represents the weighted average of tissue oxygenation. In other words, it shows the balance between oxygen need and oxygen delivery rather than oxygen delivery 2,5 . There are other devices developed to evaluate tissue oxygenation that use different techniques.…”